Youness Jouilil, Houda Lechheb, Hicham Ouakil


The general objective of this research paper is to evaluate the causal effect of RAMed medical insurance coverage on health care expenditures of poor and vulnerable families in Morocco. To do this, we used a longitudinal data from the second (2013) and third (2015) waves of the Household Panel Survey, which were produced by the National Observatory of Human Development. In this respect, we used the quasi-experimental technique called difference in difference to estimate the real impact of the RAMed medical scheme on health care expenditures. The econometric modelling shows that the impact of RAMed on health expenditure depends on the multi-faceted interactions between the diet and the characteristics of the patient. In addition, the results suggested that RAMed health coverage does not reduce the health costs of the poor families. In fact, after controlling for observable characteristics such as age, marital status, area of residence and standard of living, we found that the policy evaluated had a negative and statistically insignificant impact at the critical threshold 5% on the treaty group. That means, people who are covered by RAMed spend like those who not covered by any health insurance plan, even when are taking into account the characteristics of household. Hence, the implementation of the RAMed program has been associated with an increase in healthcare expenditure, particularly indirect expenses incurred by households (transport, accommodation costs, support costs, etc.). This supports the fact that poor and vulnerable Moroccan households contribute in financing of health care despite the State’s efforts made in order to ameliorate this regime. Therefore, the review of this scheme is necessary in order to ensure the sustainability of its services especially with regard to the flexibility of non-compliance with the pathway of care by patients especially for those who come from rural areas and the acceleration of the implementation of advanced regionalization, which will make it possible to have one hospital per region.


JEL: E20, E22, L60, L81


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impact assessment, RAMed health coverage, difference-in-differences, health care expenditures, household panel survey data

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